BIOLOGICALLY TARGETED THERAPIES

Targeted therapies work by focusing on specific cancer genes, proteins or other substances that are necessary for particular cancer cells to grow and divide. The aim of all targeted therapies is to attack the cancer cells, while limiting damage to normal cells. Some of these medications block (inhibit) the biological signals that cancer cells receive – signals that tell them to multiply at an uncontrolled rate and form tumours.

For select patients with pancreatic neuroendocrine tumours, medications from the mTOR inhibitor and tyrosine kinase inhibitor drug classes have shown promising anti-tumour activity.

Everolimus (Afinitor)

Indication

The treatment of well-or moderately differentiated neuroendocrine tumours of pancreatic origin (PNET) in patients with unresectable, locally advanced or metastatic disease that has progressed within the last 12 months.

NEW Indication – May 2016 – AFINITOR for the treatment of unresectable, locally advanced or metastatic, well differentiated NETs of GI or lung origin in adults with documented disease progression within 6 months and with a good performance status conditional on improved cost-effectiveness.

Dosing

10 mg daily

Funding in Canada

Afinitor in pNETs

British Columbia – Funded
Alberta – Funded
Saskatchewan – Funded
Manitoba – Funded
Ontario – Funded
Quebec – Funded
Nova Scotia – Funded
New Brunswick – Funded
Newfoundland – Funded
PEI – Under Provincial Consideration

Afinitor in Lung/GI

Positive recommendation from pCODR – October 2016. Funding status pending.

Clinical Evidence

Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study. Reference – RADIANT-2 – Lancet 2011 Dec 10;378(9808):2005

Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study. Reference – RADIANT-4 trial (Lancet 2016 Mar 5;387(10022):968), editorial can be found in Lancet 2016 Mar 5;387(10022):924

Product Monograph

afinitor_scrip_e

Novartis ACCESS Program

Everolimus

Afinitor

Novartis

Novartis ACCESS Program

1-866-281-4688

Hours: 8:00_AM – 8:00_PM ET

Sunitinib (Sutent)

Indication

The treatment of patients with unresectable locally advanced or metastatic, well differentiated pancreatic neuroendocrine tumours (pancreatic NET), whose disease is progressive. Approval for pancreatic NET is based on progression free survival in patients with good performance status.

Dosing

12.5 mg, 25 mg, 37.5 mg, 50 mg sunitinib per capsule 37.5 mg daily

Funding in Canada

Clinical Evidence

BELZUTIFAN

Indication

Belzutifan is used to treat Von Hippel Lindau disease (VHL) and targets the underlying mechanism of tumors that occur in VHL disease, including pancreatic neuroendocrine tumors (pNETs). In VHL disease, mutations in the VHL gene lead to the overproduction of HIF-2α, which drives the development of various tumors, including pNETs. Belzutifan is approved in Canada for treating these VHL-associated tumors by inhibiting the HIF-2α protein, which causes the excessive cell growth that leads to these cancers. By inhibiting HIF-2α, belzutifan stops the pathway that causes tumor growth and proliferation.

INDICATION
Belzutifan is indicated for Von Hippel-Lindau (VHL) disease
For the treatment of adult patients with von Hippel-Lindau (VHL) disease who require therapy for associated non-metastatic renal cell carcinoma (RCC), central nervous system (CNS) hemangioblastomas, or non-metastatic pancreatic neuroendocrine tumors (pNET), not requiring immediate surgery. Efficacy in patients with VHL disease-associated RCC, CNS hemangioblastomas, or pNET was based on objective response rate and duration of response in a single-arm study.